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The hip fluid seal—Part I: the effect of an acetabular labral tear, repair, resection, and reconstruction on hip fluid pressurization

  • Marc J. Philippon
  • Jeffrey J. Nepple
  • Kevin J. Campbell
  • Grant J. Dornan
  • Kyle S. Jansson
  • Robert F. LaPrade
  • Coen A. Wijdicks
Hip

Abstract

Purpose

The acetabular labrum is theorized to be important to normal hip function by creating intra-articular fluid pressurization through the hip fluid seal. However, the effect of a labral tear or partial labral resection, and interventions including labral repair and labral reconstruction, on the hip fluid seal remains to be defined. The purpose of this study was to characterize intra-articular fluid pressurization in six labral conditions: intact, tear, repair (looped vs. through sutures), partial resection, reconstruction with iliotibial band, and complete resection.

Methods

Eight cadaveric hips with a mean age of 47.8 years (SD 4.3, range 41–51) were included in the study. For each labral condition, the hip was compressed with a force of 2.7 times body weight (2,118 N) while intra-articular pressure was continuously measured with 1.0 × 0.3 mm pressure transducers. Peak intra-articular pressure measurements for each condition were normalized relative to the intact state. Statistical analyses were performed utilizing linear mixed-effects models with repeated measures analysis.

Results

Intra-articular fluid pressurization of the intact state varied from 78 to 422 kPa (mean 188 kPa ± SD 120). Labral tear, partial resection, and complete resection resulted in average pressurization of 75 ± 33, 53 ± 37, and 24 ± 18 %, respectively compared with the intact state. Through type labral repair resulted in significantly greater increases in pressurization from the labral tear state, compared with the looped type repair (median increase; +46 vs. −12 %, p = 0.029). Labral reconstruction resulted in a mean pressurization of 110 ± 38 % relative to intact state, with a significant 56 ± 47 % improvement in pressurization compared with partial labral resection (p = 0.009).

Conclusions

Partial labral resection caused significant decreases in intra-articular fluid pressurization. Through type labral suture repair restored the fluid pressurization better than looped type repairs. Labral reconstruction significantly improved pressurization to levels similar to the intact state. This study demonstrated the effect of labral tears and partial resections on intra-articular fluid pressurization via the hip fluid seal, and it also demonstrated improvements in pressurization seen with through type labral repairs and labral reconstructions.

Keywords

Hip seal Labral repair Labral reconstruction Fluid pressurization 

Notes

Acknowledgments

We would like to thank Penny Bortz, RN and Jane Roehrig, RN for their assistance in labral reconstruction graft preparation and Kelly Adair for his assistance in specimen acquisition.

Conflict of interest

Smith & Nephew Endoscopy provided unrestricted in-kind donations of the surgical tools utilized in this study.

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Copyright information

© Springer-Verlag Berlin Heidelberg 2014

Authors and Affiliations

  • Marc J. Philippon
    • 1
    • 2
  • Jeffrey J. Nepple
    • 1
  • Kevin J. Campbell
    • 1
  • Grant J. Dornan
    • 1
  • Kyle S. Jansson
    • 1
  • Robert F. LaPrade
    • 1
    • 2
  • Coen A. Wijdicks
    • 1
  1. 1.Steadman Philippon Research InstituteVailUSA
  2. 2.The Steadman ClinicVailUSA

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